Transmission Precautions for Monkeypox Infection

What precautions are needed for a surgical patient with suspected or confirmed monkeypox infection?

Human-to-human transmission of monkeypox virus occurs by direct contact with lesion material or from exposure to respiratory secretions. In the perioperative setting, follow standard, contact, droplet, and airborne precautions for patients who are suspected or confirmed to have monkeypox.  PPE used by personnel who enter the patient’s room should include a gown, gloves, eye protection, and NIOSH-approved surgical N95 or higher-level respirator.

Patients should be screened for symptoms preoperatively. Symptoms develop five to 21 days after exposure and include:

• Fever
• Chills
• Swollen lymph nodes
• New skin rash

Elective surgery should be postponed for a patient who has a suspected or confirmed monkeypox until the patient is determined to be noninfectious. If surgery cannot be postponed, the surgery should be scheduled when a minimum number of perioperative personnel are present and at the end of the day when possible.

Place the patient in an airborne infection isolation room (AIIR) if one is available, including during surgery and postoperative recovery. If an AIIR is not available, consult with an infection preventionist to determine whether supplemental air-cleaning technologies (eg, portable HEPA filtration) are necessary. After cough-inducing procedures (eg, intubation, extubation, bronchoscopy) are performed in the OR on a patient who requires airborne precautions, restrict room access until 99% of airborne particles have been removed from the air (eg, 15 air exchanges per hour for 28 minutes to remove 99.9% of airborne contaminants).

Standard cleaning and disinfection procedures should be performed using an EPA-registered hospital-grade disinfectant with an emerging viral pathogen claim. Products with Emerging Viral Pathogens claims may be found on EPA’s List Q. Follow the manufacturer’s directions for concentration, contact time, and care and handling.

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Resources:

• ANA/APIC Monkeypox Screening Tool
• CDC: Infection Prevention and Control of Monkeypox in Healthcare Settings
• CDC: Monitoring People Who Have Been Exposed
• CDC: Reducing Stigma in Monkeypox Communication and Community Engagement
• AORN Guideline for Transmission Based Precautions. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
• Guidelines for Environmental Infection Control in Health-Care Facilities (2003), Appendix B. Air. Centers for Disease Control and Prevention.

Updated August 8, 2022